MEDICARE: MS. JILL KOLIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	44221	CA
2	183500000X	Pharmacist	PS24917	FL
3	183500000X	Pharmacist	039707	NY

General Provider Information

NPI Number	:	1104224724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JILL KOLIN

Provider Business Mailing Address
First Line	:	7100 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5896
Country	:	US
Telephone Number	:	323-603-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90046-5896
Country	:	US
Telephone Number	:	323-603-0005
Fax Number	:	323-603-0707

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2014
Last Update Date	:	12/13/2014

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